A Health Podyssey

Sixty-eight percent of undocumented immigrants in the United States come from Mexico or Central America. As a result, deportation policies have a disproportionate effect on people of Hispanic origin.Immigration enforcement activity may influence behaviors like obtaining health care services; the effects of which can be felt throughout the community. On today's episode of A Health Podyssey, Abigail Friedman from the Yale School of Public Health joins the program to discuss the relationship between immigration enforcement and health care use. In the July issue of Health Affairs, which focuses exclusively on Borders, Immigration & Health, Dr. Friedman and coauthor Atheendar Venkataramani from the University of Pennsylvania analyzed the relationship between immigration enforcement activity and health care use. They focused on the comparison between adults of Hispanic origins and those not of Hispanic origin.The study ultimately found that aggressive deportation enforcement in the US may make undocumented immigrants and those close to them reluctant to seek medical care.Listen to Health Affairs Editor-in-Chief Alan Weil interview Abigail Friedman from the Yale School of Public Health on the chilling effects of US immigration enforcement, where undocumented immigrants and their families forgo necessary care for fear of attracting immigration authorities’ attention.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Roughly 45 million immigrants live in the United States today, a fourfold increase since the 1960s. Immigrants face unique challenges obtaining health care services. Some of the challenges are caused by explicit policies designed to limit or exclude immigrants from programs and benefits available to people born in the US. Other barriers relate to household income or the greater likelihood of having limited English proficiency.The health of immigrants in the United States is the topic of today's A Health Podyssey. Arturo Vargas Bustamante is a professor at the UCLA Fielding School of Public Health and faculty director of research at the UCLA Latino Policy and Politics Initiative. For the July issue of Health Affairs - focused exclusively on borders, immigrants and health - Bustamante and coauthors published a paper describing a range of health policy issues raised by the shifting demography of US immigrants. They explored health insurance, health status, and access to care over the past two decades across the immigration and citizenship continuum. They found that inequities between immigrants and US-born residents increased after The Great Recession and began to decline after the implementation of the Affordable Care Act.Listen to Health Affairs Editor-in-Chief Alan Weil interview UCLA's Arturo Vargas Bustamante about the health of immigrants in the US today and how the shifting demographics of the US are affecting health policies.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

With the US becoming more focused on addressing mental health, one important topic is how society responds to people experiencing mental health crises. A typical crisis response involves a 911 dispatcher sending a police officer to respond and provide support. However, the vast majority of police officers have little or no training for how to best respond to those in mental health crises. In addition, people with serious mental health disorders are at elevated risk of being harmed in confrontations with the police.About 30 years ago in Eugene, Oregon, a small group created an alternative program for people in crisis by sending trained mental health workers and EMTs to people experiencing mental health crises instead of the police. The program is called CAHOOTS (Crisis Assistance Helping Out On The Streets) and it's become a model for similar efforts around the country.The organization, run by White Bird Clinic, is the subject of a Leading To Health article in the June 2021 issue of Health Affairs. On today's A Health Podyssey, CAHOOTS co-founder David Zeiss joins Health Affairs Editor-in-Chief Alan Weil to discuss diverting people in a mental health crisis from a police response to a system designed around mental health needs. Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Gun violence harms the health of victims and witnesses, but it also disrupts community social cohesion and behavioral norms. The people in communities that have experienced violence can suffer adverse health consequences, including post-traumatic stress disorder.Exposure to gun violence and the disproportionate burden of that violence in certain communities is the topic of today's A Health Podyssey. Sarah James, a postdoctoral fellow at Cornell University, joins Health Affairs Editor-in-Chief Alan Weil to discuss her research on adolescent exposure to deadly gun violence published in the June 2021 issue of Health Affairs. She and her coauthors analyzed data about adolescents living or attending school near a deadly gun violence incident in the past year. They found stark trends by race and ethnicity as well as income level.Listen to Health Affairs Editor-in-Chief Alan Weil interview Sarah James on the effects of adolescent exposure to deadly gun violence within 500 meters of home or school.This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Almost all commercial insurance plans have cost-sharing provisions where patients help pay for their health care services. Annual deductibles — which patients have to meet before insurance pays anything at all — and co-payments — where the patient pays either a fixed amount for or a share of the cost of each service received — are common examples.Cost-sharing generally reduces the health insurance premium by simply shifting a share of the costs to enrollees. But it also affects utilization because having to pay for a share of the care can deter people from getting it.How cost-sharing actually works in practice is the subject of this episode's A Health Podyssey.Stacie Dusetzina from Vanderbilt University School of Medicine and Michal Horný from Emory University published a paper in the February 2021 edition of Health Affairs that analyzes the out-of-pocket spending patterns for commercially-insured individuals. They focused on the timing for when expenses are incurred.  The unique analysis points to some distorting of the provisions of a typical health insurance plan. In particular, they found that although most commercially-insured people had several health care encounters throughout the year, their out-of-pocket spending was mostly concentrated within short time intervals.Listen to Health Affairs Editor-in-Chief Alan Weil interview Stacie Dusetzina and Michal Horný on out-of-pocket health care spending.This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Lowering prescription drug prices continues to be a hot topic. Spending on biologic products, which includes most vaccines and gene therapies, was estimated at $125 billion in the United States in 2018, representing about a quarter of total pharmaceutical spending.Biosimilars, follow-on products to biologic drugs with essentially the same molecular composition to produce comparable clinical effects, are viewed by many as a way to promote competition and bring down drug prices. But the biosimilar market is young, with half of the 10 key product classes seeing marketing entry in 2018 or later. Understanding the evolving market for biosimilars is the topic of this episode of A Health Podyssey.Ariel Dora Stern, associate professor at Harvard Business School and a faculty affiliate of the Harvard-MIT Center for Regulatory Science, and coauthors published a paper in the June 2021 issue of Health Affairs examining how quickly biosimilars and follow-on products gained market share and the subsequent trajectory of drug prices.Listen to Health Affairs Editor-in-Chief Alan Weil interview Dr. Stern on what biosimilars are and how the pharmaceutical market is evolving in response to their market entry. This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Pre-order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

BONUS EPISODEAs part of Policy Spotlight, a new virtual event series from Health Affairs, Editor-in-Chief Alan Weil welcomed Elizabeth "Liz" Fowler, the new deputy administrator of the Centers for Medicare and Medicaid Services and director of its Center for Medicare and Medicaid Innovation to an in-depth discussion of Biden administration's plans and priorities for health care.The interview was conducted on June 3, 2021.As chief health council to then-Senate Finance Committee Chair Max Baucus (D-MT) at the time of the passage of the Affordable Care Act, Liz Fowler was a major force in crafting and shepherding the landmark legislation through the Senate. Later, as a vice president at The Commonwealth Fund, she was a contributor to Health Affairs’ 2020 special issue marking the 10-year anniversary of the signing of the Affordable Care Act: The ACA At 10. In her current post, Dr. Fowler will play a key role setting priorities for the future of the ACA, insurance exchanges, Medicaid expansion, and a host of other issues critical to the quality, accessibility, and affordability of American health care. Policy Spotlight features conversations with influential health policy experts in Washington, DC, and beyond. Interested in learning who is next as a speaker? Sign up for Health Affairs Today or Health Affairs Sunday Update newsletters to be the first to hear about the upcoming events. Health Affairs is grateful to the Robert Wood Johnson Foundation and The Commonwealth Fund for their support of the “Affordable Care Act Turns 10” issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Rates of burnout among primary care physicians is a growing concern in the health care workforce. Major shifts in the practice environment — from truncated office visits and growing documentation requirements to practice consolidation — have changed physicians' sense of efficacy and autonomy, both of which are important factors in work satisfaction. The COVID-19 pandemic has heightened these concerns as many physicians have been working long hours while experiencing supply shortages and facing significant health risks themselves.Samuel Edwards, assistant professor of medicine at the Oregon Health and Science University, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss his new research published in the June 2021 issue of Health Affairs investigating burnout in primary care practices.They describe the characteristics of practices where clinical and nonclinical staff both report an absence of burnout and compare them to practices where burnout rates are high.Listen to Alan Weil and Samuel Edwards discuss physician burnout, its prevalence in primary care practices, and the implications of their research on the practice of medicine.This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota. Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Skilled nursing care is an important Medicare benefit but it also accounts for significant spending.In Medicare, cost sharing applies to patients' care in skilled nursing facilities after the twentieth day of residence. This prompts a spike in discharges from facilities at that time. But does cutting short these skilled nursing facility stays at day 20 negatively impact patient health?J. Michael McWilliams, a researcher from Harvard Medical School and Brigham and Women's Hospital, and coauthors aimed to answer this question in a paper they published in the May 2021 issue of Health Affairs. They studied the extent to which skilled nursing facility discharges accelerated by Medicare cost sharing are safe.McWilliams and coauthors found no clear evidence that those who are discharged face increased risk of death, hospitalization for fall-related injuries, or all-cause hospitalizations.On this episode of A Health Podyssey, J. Michael McWilliams joins Health Affairs Editor-in-Chief Alan Weil to discuss this research and his perspective on the future of health care financing.Pre-order the July 2021 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The HITECH Act, part of the broad American Recovery and Reinvestment Act of 2009, ushered in major changes for health care's information and informatics landscape. The legislation may best be known for "meaningful use" requirements attached to hospital and/or physician funding to support the adoption of electronic health records (EHRs).The law also greatly boosted health information exchanges, or networks that share clinical information across different health care settings.On today's episode of A Health Podyssey, Dr. Julia Adler-Milstein, director of the Center for Clinical Informatics and Improvement Research at the University of California San Francisco, joins Health Affairs Editor-in-Chief Alan Weil to discuss a survey of health information exchange organizations she and colleagues published in the May 2021 issue of Health Affairs. The survey reveals a level of maturity in the field of health information exchange, but a few critical issues continue to threaten the ability to achieve the potential and promise of EHRs. Listen to Alan Weil interview Julia Adler-Milstein on the evolution of health information exchange organizations, TEFCA, and health data governance.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts